Obamacare: Trump touts death blow, but Florida sign-ups hit 1.7M

President Donald Trump said removing the penalty for lacking health insurance essentially repeals Obamacare, but sign-ups for 2018 remain close to the same in half the time — and they hit an unexpected 1.7 million in Florida.

Hearing that we matched last year’s total of 1.7 million Floridians is amazing,” said Jodi Ray, project  director for the enrollment-promotion group Covering Florida, on Friday.

Ray said it “proves not just how hard everyone worked to help as many consumers as feasibly possible, but just how great the need is and the personal desire to have health care coverage is to Floridians and Americans across the country.”

And it’s not quite over in the state with the most enrollees  in the federal marketplace. Florida residents can still sign up through Dec. 31, because of an extension related to Hurricane Irma.

The Trump administration cut the enrollment window in half to six weeks and reduced the advertising budget 90 percent. The president said this week he believes the health law is more or less nullified because the tax bill that just became law removes the penalty for not having insurance, which starts at $695.

“When the individual mandate is being repealed, that means Obamacare is repealed,” Trump said Wednesday.

“We didn’t want to bring it up,” Trump said. “I told people specifically be quiet with the fake news media because I don’t want them talking too much about it. Because I didn’t know how people would – but now that it’s approved, I can say the individual mandate on health care, where you had to pay not to have insurance, okay, think of that one. You pay not to have insurance. The individual mandate has been repealed.”

It’s possible that will still have a significant future effect on the Affordable Care Act marketplace. Congressional number-crunchers projected that if fewer healthy people sign up, it could raise premiums for remaining buyers about 10 percent.

Then again, the vast majority of Obamacare’s remaining customers are receiving government subsidies to reduce the cost of insurance — so their out-of-pocket costs change very little despite headline premium increases. Monthly premiums remain under $100 for most in Florida.

So for many, it’s still a better deal than they can find if they are not already covered by an employer’s plan or a government plan like Medicare. The people not getting a good deal are those making too much income to qualify for subsidies.

Nationally, sign-ups stand at about 8.8 million, not far from last  year’s 9.2 million.

Seema Verma, head of the Centers for Medicare and Medicaid Services, said that just proves the Trump administration administered the law more efficiently.

“This year CMS took a more cost effective outreach approach, spending just over $1 per enrollee on outreach and education for Exchange coverage compared to nearly $11 per enrollee last year,” Verma tweeted.

Please, supporters of the Affordable Care Act said. The enrollment numbers came in spite of the administration’s best efforts to kill it, they said.

“There is no reasonable justification for the administration cutting in half the time families had to enroll in coverage and slashing outreach to families,” said Frederick Isasi, executive director of  pro-ACA group Families USA.

Despite that, he said, and despite “slashing funding to provide in-person enrollment assistance, redirecting outreach money, shutting down HealthCare.gov on Sundays, and reducing the advertising budget by a startling 90 percent – families from across the nation overcame the hurdles put in their way and signed up for coverage at an unprecedented pace.”

In fact, his group says consumers set a new record for weekly enrollment Dec. 10 to December 15, when 4.1 million people selected health insurance plans on HealthCare.gov. Previous high: 4 million signing up during the week of Dec. 13 to Dec. 19, 2015.

2018 ACA Marketplace Enrollment
Florida 1.73 million
U.S 8.8 million
Source: Centers for Medicare and Medicaid through Dec. 15; excludes states with their own exchanges like California and New York.

Tax cuts: Killing Obamacare penalty could cost some Floridians $1,392

A U.S. Senate plan to cut taxes would remove the $695 or more penalty for not buying health insurance, but not everyone gets a break — if you’re 60 in Florida, it could raise your premiums a projected $1,392 in 2019, a new analysis says.

(Getty Images)

It’s no small matter in a state that once again leads the nation with more than 500,000 residents signed up so far for plans on healthcare.gov. Enrollment for 2018 ends Dec. 15.

A benchmark health plan would cost $656 more for a Floridian who is 40 and $538 more at age 27 for those buying coverage in the Obamacare marketplace,  according to the New York-based Commonwealth Fund. The 99-year-old foundation that says it aims to promote health care access for seniors, low-income people and others.

The reasoning: An estimated 13 million people nationally won’t buy health insurance without the penalty, the Congressional Budget Office says, and that affects what others pay.

Whether it’s because people don’t want it, are healthy and hope they don’t need it, or can’t afford it, having no penalty removes an incentive to buy health insurance.

A Kaiser Family Foundation analysis released this month found that 54 percent or 5.9 million of the 10.7 million people who are uninsured and eligible to purchase an Affordable Care Act marketplace plan in 2018 could pay less in premiums for health insurance than they would owe as a tax penalty.

But if folks bail on health insurance, their actions don’t just happen in a vacuum — they affect others, the argument goes.

“Since many of those expected to drop coverage in the individual market would be healthy, insurers would increase premiums to cover costs for a pool of less-healthy enrollees,” Commonwealth figures.

Not everyone thinks the impact of removing the penalty would be so severe. Rating service Standard & Poor’s, for example, predicts 3 million to 5 million fewer people will buy health insurance over a decade.

Others focus on the benefits of removing the penalty. Dumping it would free up $338 billion in the federal budget over 10 years, because fewer people would need government spending such as financial aid to lower premiums, CBO projected. That liberates more money for tax cuts, while also removing something that has long bothered small-government advocates  — it amounts to government coercion to buy a product, health insurance.

U.S. Sen. Lisa Murkowski, R-Alaska, has been a notable GOP holdout on previous Affordable Care Act overhaul efforts that she thought went too far. She signaled support for the idea last week.

“Repealing the individual mandate simply restores to people the freedom to choose,” Murkowski said. Nothing else about the health law would change, she said.

If a  tax bill killing the penalty can pass both the House and Senate, “that’s great,” White House budget director Mick Mulvaney said Nov. 19. “If it becomes an impediment to getting the best tax bill we can, then we are OK with taking it out.”

It’s a dicey political calculation that rests largely on voter perceptions: Is it welcome relief from overreaching government? Or is it pushing millions out of health coverage (and making others pay more) to deliver tax cuts that largely benefit upper-income folks? Health care was a leading issue in exit polls among Virginia voters who turned out strongly for Democrats this month.

Enrollment in Obamacare plans is running about 46 percent ahead of last year, though that’s partly because of a shorter sign-up period and it’s too soon to know how final numbers will look.

“Despite uncertainty in the market, we’re thrilled that Florida once again leads the nation in getting covered,” said Epilepsy Foundation of Florida CEO Karen Basha Egozi, whose group helps coordinate sign-up assistance.

Total enrollment has been projected to drop after the Trump administration cut budgets for advertising and in-person assistance and reduced the sign-up period by six weeks.

Estimated Florida premium hikes
Additional premium costs on benchmark Affordable Care Act marketplace policies in 2019 under a Senate tax plan to repeal the penalty for not carrying health insurance
Age 27 $538
Age 40 $656
Age 60 $1,392
Source: The Commonwealth Fund

Florida CFO asks Congress to block health tax

Florida Chief Financial Officer Jimmy Patronis sent a letter to Florida’s congressional delegation Monday urging them put  a hit on a federal Health Insurance Tax, or HIT.

Florida CFO Jimmy Patronis

Last year, Congress delayed implementation of the Affordable Care Act tax but without additional action it will become effective Jan. 1, CFO Jimmy Patronis said. Insurance companies are expected to raise rates to cover the costs.

“Congress has delayed the 2017 HIT implementation, lowering policyholders’ premiums by three percent, and saving the health care system an estimated $13.9 billion,” Patronis wrote. “However, a delay is but a temporary reprieve. Without immediate Congressional action, the tax will go into effect January 1, 2018, with a $22 billion first-year fiscal impact. With a 10-year projected impact of $267 billion, Florida simply cannot afford inaction.”

Florida faces a $1.7 billion overall increase in 2018 health care premiums, the CFO wrote. Workers in a state health plan can expect a $188 annual increase for individual coverage, and families can expect to pay an additional $518 in 2018, he said.

Who wants the tax? Insurers and business groups have repeatedly advocated for delaying it. The progressive Century Foundation has argued for keeping it to pay for Obamacare, saying delay provides little bang for the buck in lowering insurance premiums.

But in the strange-bedfellows world of Washington, GOP Congressional leaders may find it quietly useful to make the budget math look better for other tax cuts, Bloomberg noted earlier this year.

Trump order ignites debate: New health choices or destabilizing move?

President Donald Trump today touted an executive order aimed at making it easier for millions to gain access to cheaper health policies, but Florida Democrats called it “sabotage” and a national consumer group blasted it as a move to promote “junk insurance” and destabilize markets.

Trump said “we are moving toward lower costs and more options in the health care market, and taking crucial steps toward saving the American people from the nightmare of Obamacare.”

The executive order bypasses Congress and represents an attempt to guide health policy from the White House.

“While this executive order claims to help improve consumers’ access to affordable care, it would have the exact opposite effect,” said Betsy Imholz, special projects director for Consumers Union. “Allowing insurers to sell substandard association health plans that aren’t required to cover basic services and benefits will further fragment and destabilize the insurance markets as a whole. This action splits the market into two, pitting the healthy against those with preexisting conditions and life-threatening illnesses — but ultimately both groups lose in this new scheme.”

As the Palm Beach Post reported, selling policies across state lines faces certain practical limitations — insurance companies have increasingly narrow networks of health providers set up within each state. That often means plans in one state are not necessarily convenient or attractive to consumers in another.

The order instructs federal agencies to begin making rules to broaden options for small businesses and their employees to join associations that provide health coverage across state lines. Another part calls for rules allowing certain “short-term” health plans to stay in effect longer, and be renewable. A key question in both cases: Whether this lets the plans make an end run around key Obamacare regulations.

The process could take months.

Sen. Rand Paul, R-Ky., said at the White House Thursday, “Today’s a big day. President Trump is doing today what I believe is the biggest free-market reform of health care in a generation.”

It will allow “millions of people to get insurance across state lines at an inexpensive price,” Paul said.

Trump signaled his intentions late last month.

“We believe states are going to have a far bigger issue than insurance companies when it comes to this concept of selling across state lines, as each individual state has its own insurance commission that has a job to protect its own consumers,” Gordon F. Bailey III, vice president of public affairs and community engagement for Jacksonville-based Florida Blue, the state’s largest health insurer, said Sept. 28 in West Palm Beach.

Insurers will do their best to live with whatever the rules are, he said.

“Allowing health plans to offer innovative products and increasing lower cost options for businesses and individuals is not a bad thing,” Audrey S. Brown, president of the Florida Association of Health Plans, said Thursday.

Florida’s Department of Financial Services “will continue to look deeper at the concept of inter-state insurance sales — and its possible impacts on Florida’s policyholders — as the specifics of President Trump’s plan come to light,” said spokeswoman Ashley Carr said then. “Florida has fashioned itself a leader in implementing insurance consumer protections, and we’d look to see that those protections remain in place.”

On Thursday, Consumers Union’s Imholz said, “Expanding the sale of these association health plans means the growth of junk insurance — coverage that may seem affordable to consumers but actually covers very little, potentially leaving them on the hook for huge out-of-pocket costs.”

She continued, “This is yet another action that undermines the good bipartisan efforts in the Senate to actually strengthen and stabilize the health insurance markets. Consumers deserve better. Every public health stakeholder group — from insurers, to providers, hospitals, patient and public interest groups — has warned that this type of action would hurt the markets and consumers. It’s time for regulators to listen and let the Senate finish their work.”

Trump’s move was applauded by Obamacare critics, including Americans for Limited Government president Rick Manning.

“President Trump has wisely asked the Department of Labor to examine the law and body of regulation to determine whether new regulations can be put into effect allowing for the sale of association health plans across state lines,” Manning said. “The vast majority of Obamacare was written by federal bureaucrats interpreting the law via the regulatory process. President Trump’s direction to the Department of Labor will now use that same process, created by Congress, to inject competition into the health care markets. The great news is that this competition promises to allow more Americans more choices at an affordable cost, truly providing affordable health care options, unlike Obamacare.”

A statement from Florida’s Democratic Party said, “Donald Trump’s executive order will continue his sabotage of health insurance markets across the country. Trump has already caused premiums to increase for millions by deliberately creating instability, limiting funding for advertising and cutting the ACA’s open enrollment period.”


States wary on Trump talk of selling health plans across state lines

President Donald Trump’s announced plans to sign an executive order letting consumers buy health policies across state lines sent ripples through the country Thursday, and an official with Florida’s biggest insurer took note of the likely impact in West Palm Beach.

President Donald Trump (Getty images).

“We believe states are going to have a far bigger issue than insurance companies when it comes to this concept of selling across state lines, as each individual state has its own insurance commission that has a job to protect its own consumers,” said Gordon F. Bailey III, vice president of public affairs and community engagement for Jacksonville-based Florida Blue.

Companies will live by whatever rules are set, he said.

Bailey talked about what comes next for health care as the featured speaker at Palm Beach County’s Business Development Board annual luncheon in West Palm Beach Thursday.

The national advocacy group Consumers Union has warned selling across state lines could foster “junk insurance” and a “race to the bottom” for insurers to cluster in the states with the weakest consumer protections. In turn, it could undercut the ability of individual states to set their own rules to protect, say, consumers with prior health problems from being denied coverage or charged more.

Florida’s Department of Financial Services “will continue to look deeper at the concept of inter-state insurance sales — and its possible impacts on Florida’s policyholders — as the specifics of President Trump’s plan come to light,” said spokeswoman Ashley Carr. “Florida has fashioned itself a leader in implementing insurance consumer protections, and we’d look to see that those protections remain in place.”

Florida’s Office of Insurance Regulation said it will “look forward to reviewing the executive order once it is signed.”

Trump signaled his intentions before the order is actually out.

“I’ll probably be signing a very major executive order where people can go out, cross state lines, do lots of things and buy their own health care,” Trump told reporters Wednesday at the White House. “It’s being finished now. It’s going to cover a lot of territory and a lot of people, millions of people.”

Trump mentioned selling across state lines on the campaign trail, and proponents including Kentucky Republican Sen. Rand Paul say it potentially gives consumers more marketplace choices, promotes competition and could lower costs.

But others say how the order is worded is very important, because it could also undermine state-based regulation and represent a way to use one state’s laws to make an end run around another state’s consumer protections.

“We haven’t yet seen the details of any proposed Executive Order and can’t comment until we see the specifics,” said Mike Consedine, CEO of the National Association of Insurance Commissioners. “As a general matter, health insurers already have the ability to sell insurance in multiple states as long as they comply with state consumer protection and licensing laws, which many already do. The NAIC has long been opposed to any attempt to reduce or preempt state authority or weaken consumer protections.”

Insurers already have a limited ability to sell across state lines under current law and waivers to the Affordable Care Act, though as a practical matter it rarely happens because provider networks are usually set up on a state-by-state basis.

Senate Republicans said this week they could not find the votes to pass an overhaul of Obamacare. Trump’s executive order would represent an attempt to take action without waiting for congressional debate and deliberation.




Florida Obamacare hike now 45%, yet most pay same or less, OIR says

The vast majority of more than 1 million Florida Obamacare customers will pay about the same or less in 2018, state regulators said Tuesday, but about 7 percent without government subsidies could pay a whopping 45 percent more.

Insurers more than doubled their 2018 increases filed just a few months earlier, with some citing the administration’s reluctance to continue billions in “cost sharing” money that president Donald Trump has called “bailouts” for insurers.

Most consumers with a benchmark “silver” plan “will not see an out-of-pocket change, as the federal premium subsidy will also increase to absorb this extra cost,” the state’s Office of Insurance Regulation said in a statement.

In fact, a family of four earning $53,000, as well as an individual earning $27,000, may see a slight decrease in their out-of-pocket health insurance premium in 2018, officials said.

Only customers who buy Affordable Care Act marketplace plans and get no government subsidy — fewer than one in 10 in Florida — potentially face the full premium increase. And they will have off-marketplace options that could be significantly less expensive, officials noted.

Florida’s largest health insurer, Jacksonville-based Florida Blue, said it has close to 1 million customers on ACA market plans. About 66,000 of them have silver plans without government subsidies, with about 19,000 of those in South Florida including Palm Beach County. They potentially take the worst hit if premiums go up 38 percent for a Florida Blue plan, or an average of 44.7 percent for a half dozen companies offering plans on the ACA exchange.

Florida Blue officials urged those consumers to check “off-marketplace” plans once the enrollment period begins in November because they might find a significantly better deal.

The big rate increases, still awaiting final federal approval, “will look surprising on the face of it, but in fact most, if they take care to understand their individual situations, should not see a large out-of-pocket change,” said  Penny Shaffer, market president in South Florida for Florida Blue.

Still, the 45 percent jump makes for an eye-grabbing headline, even as GOP Senate leaders concluded once again Tuesday they do not have the votes to repeal or overhaul the law.

“Years before the Trump Administration came to office, Obamacare’s double-digit rate increases and onerous mandates have been squeezing the pocket books of families in Florida,” said U.S. Health and Human Services press secretary Caitlin Oakley. “Under Obamacare, premiums for individual healthcare plans available in Florida surged by more than $2,400. Floridians are once again facing skyrocketing costs and plummeting choices because of Obamacare’s fundamental failures.”

Opponents of the health law make other points: As of March 15, 93 percent Florida residents who bought health insurance on the federally facilitated exchange received a premium tax credit subsidy. That still left about 100,000 Floridians on the exchanges who don’t currently receive any subsidy and thus potentially face the full impact of rate increases.

Then there are the penalties for not having insurance: In 2015, nearly 535,000 Floridians paid $250 million in penalties to the IRS for the right to go without Obamacare.  And approximately three-quarters of Florida’s counties are projected to have two or fewer insurers offering coverage on the exchange during the upcoming plan year.

An average of 45 percent is more than double what Florida insurers were asking for 2018 just months earlier. Why?

Many insurers’ filings now assume the Trump administration cannot be counted on to continue billions of dollars in cost-sharing payments to help consumers reduce co-pays and deductibles. President Trump has called these “bailouts” for insurers. Yet in this case, squeezing the balloon in one place just increases other government subsidies and may actually increase the net amount taxpayers pay for Obamacare in 2018, according to the Kaiser Family Foundation.

The administration is also shortening the sign-up window to six weeks for 2018,  slashing 90 percent of the advertising budget to tell consumers about the marketplace and reducing money for in-person assistance to get coverage. All of that will likely reduce the number of people who enroll and affect the rates of those who do sign up, insurers figure.

Rate increases for 2018

State-approved premium increases for Affordable Care Act marketplace plans. More than 90 percent of Florida consumers will see little difference in what they actually pay each month after government subsidies, though those with government aid could face the brunt of higher prices.

1 Blue Cross & Blue Shield of Florida Inc. 38.1%
2 Celtic Insurance Co.  46.1%
3 Florida Health Care Plan Inc.  26.5%
4 Health First Commercial Plans Inc. 39.3%
5 Health Options Inc.  36.0%
6 Molina Healthcare of Florida Inc.  71.2%

Source: Florida Office of Insurance Regulation


Trump ‘hell-bent on sabotaging’ Obamacare with cuts, Florida foes say

Obamacare supporters in Florida reacted quickly to reports Thursday evening that the Trump administration plans to cut its advertising budget 90 percent to $10 million and slash money for navigators, or guides to help people sign up,  by 39 percent to about $37 million.

“Our state’s in-person assisters and outreach efforts have been a critical component in the effort to get health insurance for Florida’s diverse population,” said state Rep. Nick Duran, D-Miami. “These funds have helped build a healthy risk pool, kept premiums down, and made Florida the state with the largest enrollment numbers in the nation–all while reducing uninsured rates by double digits since the marketplace opened.”

Word of the cuts comes on the heels of reports the nation’s uninsured rate has hit a new low, according to the National Center for Health Statistics.

Former Obama health administrator Andy Slavitt tweeted an “aim to fail” strategy is in motion.

The administration has already trimmed the enrollment period on Affordable Care Act markets from three months to 45 days, Nov. 1 to Dec. 15.

“The Trump Administration is hell-bent is on sabotaging the success of the ACA in Florida by hobbling outreach efforts, guaranteeing higher rates and shorter enrollment times for people seeking care,” Duran said in a statement. “Rather than addressing problems that still exist with our healthcare system, they are making them worse. This callous decision makes little sense and hurts those that are already vulnerable in our state. Cutting funding for outreach by 90 percent does not make for a more efficient government–it makes for a crueler one.”

Attempts to reach U.S. Health and Human Services officials for comment were not immediately successful.

U.S. Rep. Lois Frankel, D-West Palm Beach, said Friday, “This is another manipulative attempt by the Trump Administration to sabotage the Affordable Care Act and will do nothing to help Americans obtain affordable, quality healthcare. These unconscionable cuts will deny millions, including those with cancer and other life threatening diseases, the information and assistance they need to get coverage and stay healthy.”


Powerball $650M Florida winner? How Obamacare affects your $2 fantasy

It’s information the truly dedicated lottery fantasizer needs: How much you’d really clear if you won the second-biggest Powerball jackpot in history, $650 million. The shelf life of that daydream lasts at least until the drawing at 10:59 p.m. Wednesday.

The floor amount you could count on being delivered in a giant pile to your Florida residence is a shade over $233 million, figures Palm Beach accountant Richard Rampell.

That assumes a lump-sum payout calculated at $411.7 million, minus its maximum tax bite. The other option is to take the $650 million parceled out in annual installments over three decades, but most winners take the lump sum.

“No state or local taxes on the winnings,” Rampell said. “Whew!”

Federal taxes are another story. The final tax amount owed could be affected by charitable donations, establishing trusts and other moves, but at the max, it involves a 39.6 percent top individual rate.

And there’s this relatively recent wrinkle: A 3.8 percent tax under the Affordable Care Act on income above $250,000.

It’s your call. View it as an unexpected $15 million-plus gift to support Obamacare if you are a fan, or a fresh reason to urge Congressional Republicans to revive a stalled effort to repeal and replace the health law if you are not.

To maximize enjoyment, just don’t focus too much on the odds of winning the top prize with a $2 ticket: about 1 in 292 million.





Trump: Enjoy Obamacare after I block billions

President Donald Trump continued a furious tweet storm Monday by again raising the specter he will cut off billions of dollars for the Affordable Care Act, which he said he will teach insurance companies and Congress a lesson.

Trump started the barrage Saturday, days after the Senate failed to pass a repeal and replace bill: “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”

Trouble is, the people who will really feel the damage are consumers if Trump or Congress kill “cost sharing” subsidies, The Palm Beach Post reported. A 20 percent premium increase is likely to result if Trump withholds an estimated $10 billion in such subsidies to cover co-pays and deductibles for 2018, the state’s biggest health insurer Florida Blue warned. More than 1 million Floridians get subsidies of various kinds to lower costs.

Florida Democrats have called that “deliberate sabotage.” Who loses? Low-income consumers are cushioned somewhat by other subsidies that adjust, but middle-income people feel the full impact of overall premium increases. And if insurers simply walk away from ACA exchanges, that reduces choice and drives up costs for everyone in the market, analysts say.

If cost-sharing payments disappear, Trump will be responsible for “the destabilization of the marketplace and the deliberate sabotage of our neighbors’ health and financial well-being,” Florida’s Democratic delegation told the president in a June 8 letter. Signing members included U.S. Rep. Lois Frankel, D-West Palm Beach, and Rep. Ted Deutch, D-Boca Raton.

OK, but at least taxpayers save some money, right? Actually, it represents a net increase of $2.3 billion in costs to taxpayers, the Kaiser Family Foundation calculated, because it drives up costs for another form of subsidy to keep premiums affordable, the Post reported.

There is no evidence Trump has been moved by such arguments.

“If ObamaCare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?” Trump tweeted Monday.

In addition to “cost sharing” subsidies, Trump is believed to be talking about cutting off employer contributions to members of Congress on their own health plans.

As political rhetoric, threatening to yank affordable health insurance from Congress might play reasonably well in some quarters, if not exactly win friends on the Hill. Handing a higher bill to ordinary folks? That may be harder to sell.


Nelson, Collins talk after GOP health bill fails

Update 4 p.m.: What now? Florida’s Democratic Sen. Bill Nelson said he’s begun working with another former insurance commissioner on the other side of the aisle, Susan Collins of Maine. She was one of three GOP no votes.

U.S. Sen. Bill Nelson, D-Fla.

“Sen. Collins and I have discussed this issue many times and we are now working together,” Nelson said in a statement. “As former state insurance commissioners, we know how complicated this issue is and we are working with a small bipartisan group of senators equally dedicated to finding real solutions.”

Nelson earlier pitched a plan he says could lower premiums 13 percent, based on discussions with people in the business. A bill he filed would create a reinsurance fund to reimburse insurers 80 percent of claims ranging from $50,000 to $500,000 from 2018 until 2020. After that, the fund would cover 80 percent of claims ranging from $100,000 to $500,000.

It remains to be seen how that would play with GOP members who have been trying to roll back Obamacare in the name of smaller government.

But Nelson’s case goes like this from a June 15 statement: “The reinsurance fund would be available to health insurance companies participating in state and federal exchanges, encouraging these companies to offer more plans in more markets. This increased competition among insurers would eventually help drive down prices for consumers who purchase health insurance through HealthCare.gov.”

Update 1:39 am: Seven years of efforts to repeal and replace Obamacare failed in a 51-49 Senate vote against a “skinny” repeal plan, with Arizona Republican Sen. John McCain casting a critical no vote.

Senate majority leader Mitch McConnell called the vote “disappointing.”

Florida Republican Marco Rubio voted yes. Democrat Bill Nelson voted no

“We’re not interested in throwing money at insurance companies, ” said Sen. John Cornyn, R-Texas, before the vote. “We’re doing everything we can while our Democratic friends are sitting on their hands.”

President Donald Trump tweeted, “3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!”

“The skinny repeal package makes a mockery of the president’s pledge to lower premiums,” said U.S Sen. Ron Wyden, D-Oregon.

Original  post: The American Medical Association, the biggest organization representing U.S. doctors, blasted a “skinny repeal” of the Affordable Care Act unveiled in the U.S. Senate tonight.

“Action is needed to address problems in the individual insurance market, but the so-called ‘skinny’ bill is a toxic prescription that would make matters worse,” said David O. Barbe, AMA’s president.

The plan would remove the penalty for individuals and employers for failing to obtain insurance coverage and remove a medical devices tax. That might come as welcome news for those who don’t want the government forcing them to buy insurance, but the practical effect is likely 16 million drop out of coverage and premiums for those remaining rise 20 percent, the Congressional Budget Office projected.

Even some Senate Republicans expressed concern that there should be guarantees it will be a vehicle to negotiate with the House, not a final policy.

“The skinny bill as policy is a disaster,” said Sen. Lindsey Graham, R-South Carolina. “The skinny bill as a replacement for Obamacare is a fraud.”

Senate leadership had to contend with opposition from groups from AARP to AMA.

“Eliminating the individual mandate will lead to adverse selection, triggering higher premiums and further destabilizing the individual market,” AMA’s Barbe said. “The stated goal was to advance policies to lower premiums, but the ‘skinny’ bill would do the exact opposite, harming patients across the country.

“Further, the bill would result in millions more Americans without health insurance coverage.

“Again, we urge Senators to oppose the ‘skinny’ bill and to pivot to a bipartisan effort, working through appropriate committees of jurisdiction and regular order to fix problems and gaps in current law to enable Americans to obtain quality, affordable health insurance.”

Insomniacs can follow the live debates on cable channels as debate continued past 11 p.m